High case fatality cholera outbreak in Western Kenya, August 2010

Geographical distribution and antibiotics susceptibility patterns of toxigenic Vibrio cholerae isolates from Kisumu County, Kenya

Background

Multiple drug resistance has become a major threat to the treatment of cholera. Recent studies in Kenya have described the epidemiology, especially the risk factors, of cholera; however, there is little information on the phenotypic and drug susceptibility patterns of Vibrio cholerae (V. cholerae) in outbreaks that in the recent past have occurred in western Kenya.

Aim

To characterise and determine the antibiotics’ susceptibility profiling of toxigenic V. cholerae isolates from Kisumu County.

Setting

The project was conducted in Kisumu County, Kenya.

Methods

A total of 119 V. cholerae O1, biotype El Tor, isolates collected during 2017 cholera outbreak in Kisumu County were used for this study. The samples were cultured on thiosulphate-citrate-bile salts sucrose (TCBS) agar and biochemical tests were carried out using standard procedures. Susceptibility tests were conducted by using various conventional antibiotics against standard procedures.

Results

Of the 119 isolates, 101 were confirmed to be V. cholerae belonging to serotypes Inaba and Ogawa, with Inaba being the predominant serotype (73.95%). The isolates were susceptible to ciprofloxacin (100%), ofloxacin (100%), gentamycin (100%), doxycycline (99%), ceftriaxone (99%) and streptomycin (96.04%) antimicrobials, and resistant to erythromycin (53.47%), amoxicillin (64.4%), nalidixic acid (83.2%) and ampicillin (89.11%), with high resistance to cotrimoxazole (99%) and tetracycline (97%).

Conclusion

Vibrio cholerae was resistant to multiple antibiotics, including those commonly used in the management of cholera. Taken together, there is a need to carry out regular surveillance on antimicrobial drug resistance during outbreaks.

A protracted cholera outbreak among residents in an urban setting, Nairobi county, Kenya, 2015

Introduction

in 2015, a cholera outbreak was confirmed in Nairobi county, Kenya, which we investigated to identify risk factors for infection and recommend control measures.

Methods

we analyzed national cholera surveillance data to describe epidemiological patterns and carried out a case-control study to find reasons for the Nairobi county outbreak. Suspected cholera cases were Nairobi residents aged >2 years with acute watery diarrhea (>4 stools/≤12 hours) and illness onset 1-14 May 2015. Confirmed cases had Vibrio cholerae isolated from stool. Case-patients were frequency-matched to persons without diarrhea (1:2 by age group, residence), interviewed using standardized questionaires. Logistic regression identified factors associated with case status. Household water was analyzed for fecal coliforms and Escherichia coli.

Results

during December 2014-June 2015, 4,218 cholera cases including 282 (6.7%) confirmed cases and 79 deaths (case-fatality rate [CFR] 1.9%) were reported from 14 of 47 Kenyan counties. Nairobi county reported 781 (19.0 %) cases (attack rate, 18/100,000 persons), including 607 (78%) hospitalisations, 20 deaths (CFR 2.6%) and 55 laboratory-confirmed cases (7.0%). Seven (70%) of 10 water samples from communal water points had coliforms; one had Escherichia coli. Factors associated with cholera in Nairobi were drinking untreated water (adjusted odds ratio [aOR] 6.5, 95% confidence interval [CI] 2.3-18.8), lacking health education (aOR 2.4, CI 1.1-7.9) and eating food outside home (aOR 2.4, 95% CI 1.2-5.7).

Conclusion

we recommend safe water, health education, avoiding eating foods prepared outside home and improved sanitation in Nairobi county. Adherence to these practices could have prevented this protacted cholera outbreak.

An outbreak of cholera in western Kenya, 2015: a case control study

Introduction

in February 2015, an outbreak of acute watery diarrhea was reported in two sub counties in western Kenya. Vibrio cholerae 01 serotype Ogawa was isolated from 26 cases and from water samples collected from a river mainly used by residents of the two sub-counties for domestic purposes. We carried out an investigation to determine factors associated with the outbreak.

Methods

we conducted a frequency matched case control study in the community. We defined cases as episodes of watery diarrhea (at least three motions in 24 hours) in persons ≥ 2 years who were residents of Rongo or Ndhiwa sub-counties from January 23-February 25, 2015. Cases were systematically recruited from a cholera line list and matched to two controls (persons without diarrhea since January 23, 2015) by age category and residence. A structured questionnaire was administered to evaluate exposures in cases and controls and multivariable logistic regression done to determine independent factors associated with the outbreak.

Results

we recruited 52 cases and 104 controls. Females constituted 61% (95/156) of all participants. Overall latrine coverage was 58% (90/156). Latrine coverage was 44% (23/52) for cases and 64% (67/104) for controls. Having no latrine at home (aOR = 10.9; 95% CI: 3.02-39.21), practicing communal hand washing in a basin (aOR = 6.5; 95% CI: 2.30-18.11) and vending of food as an occupation (aOR = 3.4; 95% CI: 1.06-10.74) were independently associated with the outbreak.

Conclusion

poor latrine coverage and personal hygiene practices were identified as the main drivers of the outbreak. We recommended improved public health education on latrine usage and promotion of hand washing with soap and water in the community.

Factors associated with cholera in Kenya, 2008-2013

INTRODUCTION

Kenya experienced widespread cholera outbreaks in 1997-1999 and 2007-2010. The re-emergence of cholera in Kenya in 2015 indicates that cholera remains a public health threat. Understanding past outbreaks is important for preventing future outbreaks. This study investigated the relationship between cholera occurrence in Kenya and various environmental and demographic factors related to water, sanitation, socio-economic status, education, urbanization and availability of health facilities during the time period 2008-2013.

METHODS

The primary outcome analyzed was the number of cholera cases at the district level, obtained from the Kenya Ministry of Health's national cholera surveillance records. Values of independent variables were obtained from the 2009 Kenya Population and Housing Census and other national surveys. The data were analyzed using a zero-inflated negative binomial regression model.

RESULTS

Multivariate analysis indicated that the risk of cholera was associated with open defecation, use of unimproved water sources, poverty headcount ratio and the number of health facilities per 100,000 population (p < 0.05). No statistically significant association was found between cholera occurrence and education, percentage of population living in urban areas or population density.

CONCLUSION

The Sustainable Development Goals and Kenya's blueprint for development, Kenya Vision 2030, call for access to sanitation facilities and clean water for all by 2030. Kenya has made important economic strides in recent years but continues to be affected by diseases like cholera that are associated with low socio-economic status. Further expansion of access to sanitation facilities and clean water is necessary for preventing cholera in Kenya.